Spanish study links pharmaceutical spending changes with lower treatable mortality

Researchers analysed annual data from 17 Spanish regions over 2001–2019 using a cross-sectional time-series design. They assessed whether short-term changes in government expenditure on retail pharmaceuticals (GERP) and on other health goods and services were associated with changes in age- and sex-standardised mortality, stratified by age, avoidability and cause. Regression models adjusted for relevant covariates; a 2001–2013 sub-analysis also accounted for government social expenditure.

A 1% increase in the two-year mean change in GERP was associated with lower premature treatable mortality (elasticity −0.23%). Associations were also observed for premature respiratory, infectious and circulatory mortality (−0.56%, −0.49% and −0.22%, respectively). In analyses combining avoidability and cause, the largest inverse associations were for premature treatable mortality from infectious causes (−1.60%) and respiratory causes (−0.88%). Associations with non-premature mortality weakened considerably after adjustment for social expenditure. Results for other health expenditure were generally weaker and not statistically significant.

These regional, population-level findings describe associations over a short time frame and cannot show that higher pharmaceutical spending caused mortality to fall. The attenuation after social-expenditure adjustment also limits interpretation, particularly for older populations. The study does not identify which medicines or spending changes drove the observed patterns.